European Radiology

, Volume 19, Issue 8, pp 1981–1990 | Cite as

Diffusion-weighted magnetic resonance imaging of pancreas tumours

  • Nikolaos Kartalis
  • Terri L. Lindholm
  • Peter Aspelin
  • Johan Permert
  • Nils Albiin


The purpose of this study was to evaluate the accuracy of diffusion-weighted imaging (DWI) in diagnosis of pancreas cancer, to compare DWI with a conventional comprehensive MRI (MRI-c) and to analyse apparent diffusion coefficient (ADC) values of lesions. Thirty-six patients with pancreatic lesions (12 malignant and 24 benign) and 39 patients without lesions were included. MRI-c and DWI (free breathing, b values 0 and 500 s/mm2) were performed prospectively and consecutively in a 1.5-T system. The analysis was retrospectively performed blinded by two radiologists in consensus. The sensitivity, specificity, accuracy, and positive and negative predictive values of DWI and MRI-c were 92, 97, 96, 85, 98% and 100, 97, 97, 86, 100%, respectively. Mean ADC values of malignant lesions were significantly lower than those of benign lesions. DWI has a similar accuracy to MRI-c in diagnosis of pancreas cancer.


Pancreas Magnetic resonance imaging Diffusion-weighted imaging Neoplasm Inflammation 


  1. 1.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics, 2008. CA Cancer J Clin 58(2):71–96PubMedCrossRefGoogle Scholar
  2. 2.
    Li D, Xie K, Wolff R, Abbruzzese JL (2004) Pancreatic cancer. Lancet 363(9414):1049–1057PubMedCrossRefGoogle Scholar
  3. 3.
    Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M (1986) MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurological disorders. Radiology 161(2):401–407PubMedGoogle Scholar
  4. 4.
    Robertson RL, Glasier CM (2007) Diffusion-weighted imaging of the brain in infants and children. Pediatr Radiol 37(8):749–768PubMedCrossRefGoogle Scholar
  5. 5.
    Eustace S, DiMasi M, Adams J, Ward R, Caruthers S, McAlindon T (2000) In vitro and in vivo spin echo diffusion imaging characteristics of synovial fluid: potential non-invasive differentiation of inflammatory and degenerative arthritis. Skeletal Radiol 29(6):320–323PubMedCrossRefGoogle Scholar
  6. 6.
    Nonomura Y, Yasumoto M, Yoshimura R, Haraguchi K, Ito S, Akashi T, Ohashi I (2001) Relationship between bone marrow cellularity and apparent diffusion coefficient. J Magn Reson Imaging 13(5):757–760PubMedCrossRefGoogle Scholar
  7. 7.
    Morgan VA, Kyriazi S, Ashley SE, DeSouza NM (2007) Evaluation of the potential of diffusion-weighted imaging in prostate cancer detection. Acta Radiol 48(6):695–703PubMedCrossRefGoogle Scholar
  8. 8.
    Matsuki M, Inada Y, Tatsugami F, Tanikake M, Narabayashi I, Katsuoka Y (2007) Diffusion-weighted MR imaging for urinary bladder carcinoma: initial results. Eur Radiol 17(1):201–204PubMedCrossRefGoogle Scholar
  9. 9.
    Tamai K, Koyama T, Saga T, Morisawa N, Fujimoto K, Mikami Y, Togashi K (2008) The utility of diffusion-weighted MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol 18(4):723–730PubMedCrossRefGoogle Scholar
  10. 10.
    Ichikawa T, Erturk SM, Motosugi U, Sou H, Iino H, Araki T, Fujii H (2006) High-b-value diffusion-weighted MRI in colorectal cancer. AJR Am J Roentgenol 187(1):181–184PubMedCrossRefGoogle Scholar
  11. 11.
    Bruegel M, Holzapfel K, Gaa J, Woertler K, Waldt S, Kiefer B, Stemmer A, Ganter C, Rummeny EJ (2008) Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 18(3):477–485PubMedCrossRefGoogle Scholar
  12. 12.
    Gourtsoyianni S, Papanikolaou N, Yarmenitis S, Maris T, Karantanas A, Gourtsoyiannis N (2008) Respiratory gated diffusion-weighted imaging of the liver: value of apparent diffusion coefficient measurements in the differentiation between most commonly encountered benign and malignant focal liver lesions. Eur Radiol 18(3):486–492PubMedCrossRefGoogle Scholar
  13. 13.
    Ichikawa T, Erturk SM, Motosugi U, Sou H, Iino H, Araki T, Fujii H (2007) High-b value diffusion-weighted MRI for detecting pancreatic adenocarcinoma: preliminary results. AJR Am J Roentgenol 188(2):409–414PubMedCrossRefGoogle Scholar
  14. 14.
    Matsuki M, Inada Y, Nakai G, Tatsugami F, Tanikake M, Narabayashi I, Masuda D, Arisaka Y, Takaori K, Tanigawa N (2007) Diffusion-weighted MR imaging of pancreatic carcinoma. Abdom Imaging 32(4):481–483PubMedCrossRefGoogle Scholar
  15. 15.
    Takeuchi M, Matsuzaki K, Kubo H, Nishitani H (2008) High-b-value diffusion-weighted magnetic resonance imaging of pancreatic cancer and mass-forming chronic pancreatitis: preliminary results. Acta Radiol 49(4):383–386PubMedCrossRefGoogle Scholar
  16. 16.
    Birchard KR, Semelka RC, Hyslop WB, Brown A, Armao D, Firat Z, Vaidean G (2005) Suspected pancreatic cancer: evaluation by dynamic gadolinium-enhanced 3D gradient-echo MRI. AJR Am J Roentgenol 185(3):700–703PubMedGoogle Scholar
  17. 17.
    Fletcher JG, Wiersema MJ, Farrell MA, Fidler JL, Burgart LJ, Koyama T, Johnson CD, Stephens DH, Ward EM, Harmsen WS (2003) Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology 229(1):81–90PubMedCrossRefGoogle Scholar
  18. 18.
    Farma JM, Santillan AA, Melis M, Walters J, Belinc D, Chen DT, Eikman EA, Malafa M (2008) PET/CT fusion scan enhances CT staging in patients with pancreatic neoplasms. Ann Surg Oncol 15(9):2465–2471PubMedCrossRefGoogle Scholar
  19. 19.
    Agarwal B, Abu-Hamda E, Molke KL, Correa AM, Ho L (2004) Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. Am J Gastroenterol 99(5):844–850PubMedCrossRefGoogle Scholar
  20. 20.
    Schick V, Franzius C, Beyna T, Oei ML, Schnekenburger J, Weckesser M, Domschke W, Schober O, Heindel W, Pohle T, Juergens KU (2008) Diagnostic impact of (18)F-FDG PET-CT evaluating solid pancreatic lesions versus endosonography, endoscopic retrograde cholangio-pancreatography with intraductal ultrasonography and abdominal ultrasound. Eur J Nucl Med Mol Imaging 35(10):1775–1785PubMedCrossRefGoogle Scholar
  21. 21.
    Noguchi K, Watanabe N, Nagayoshi T, Kanazawa T, Toyoshima S, Shimizu M, Seto H (1999) Role of diffusion-weighted echo-planar MRI in distinguishing between brain abscess and tumour: a preliminary report. Neuroradiology 41(3):171–174PubMedCrossRefGoogle Scholar
  22. 22.
    Mishra AM, Gupta RK, Saksena S, Prasad KN, Pandey CM, Rathore D, Purwar A, Rathore RK, Husain N, Jha DK, Jaggi RS, Husain M (2005) Biological correlates of diffusivity in brain abscess. Magn Reson Med 54(4):878–885PubMedCrossRefGoogle Scholar
  23. 23.
    Tsushima Y, Takano A, Taketomi-Takahashi A, Endo K (2007) Body diffusion-weighted MR imaging using high b-value for malignant tumor screening: usefulness and necessity of referring to T2-weighted images and creating fusion images. Acad Radiol 14(6):643–650PubMedCrossRefGoogle Scholar
  24. 24.
    Liapi E, Geschwind JF, Vossen JA, Buijs M, Georgiades CS, Bluemke DA, Kamel IR (2008) Functional MRI evaluation of tumor response in patients with neuroendocrine hepatic metastasis treated with transcatheter arterial chemoembolization. AJR Am J Roentgenol 190(1):67–73PubMedCrossRefGoogle Scholar
  25. 25.
    Kamel IR, Bluemke DA, Ramsey D, Abusedera M, Torbenson M, Eng J, Szarf G, Geschwind JF (2003) Role of diffusion-weighted imaging in estimating tumor necrosis after chemoembolization of hepatocellular carcinoma. AJR Am J Roentgenol 181(3):708–710PubMedGoogle Scholar
  26. 26.
    Lee SS, Byun JH, Park BJ, Park SH, Kim N, Park B, Kim JK, Lee MG (2008) Quantitative analysis of diffusion-weighted magnetic resonance imaging of the pancreas: usefulness in characterizing solid pancreatic masses. J Magn Reson Imaging 28(4):928–936PubMedCrossRefGoogle Scholar
  27. 27.
    Yamada I, Aung W, Himeno Y, Nakagawa T, Shibuya H (1999) Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging. Radiology 210(3):617–623PubMedGoogle Scholar
  28. 28.
    Kim T, Murakami T, Takahashi S, Hori M, Tsuda K, Nakamura H (1999) Diffusion-weighted single-shot echoplanar MR imaging for liver disease. AJR Am J Roentgenol 173(2):393–398PubMedGoogle Scholar
  29. 29.
    Rulyak SJ, Kimmey MB, Veenstra DL, Brentnall TA (2003) Cost-effectiveness of pancreatic cancer screening in familial pancreatic cancer kindreds. Gastrointest Endosc 57(1):23–29PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Nikolaos Kartalis
    • 1
  • Terri L. Lindholm
    • 3
  • Peter Aspelin
    • 1
  • Johan Permert
    • 2
  • Nils Albiin
    • 1
  1. 1.Division of Radiology, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
  2. 2.Division of Surgery, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
  3. 3.Department of Diagnostic Medical PhysicsKarolinska University Hospital HuddingeStockholmSweden

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